by Michael Toze.
Right. I’ve got the navel gazing out of the way now. Let’s try something a bit more theoretical.
This morning I listened to Ayona Datta talking about urban futures, focusing on Smart Cities in India.
The other big thing that’s been going on for me today on social media, as a trans researcher (in both senses of the term) is that the new version of the International Classification of Diseases has recently been published. In the ICD-11 the former medical diagnosis of ‘transsexualism’ has now been replaced by ‘gender incongruence’, which is also no longer in the mental health section of the manual.
Urban development in India and trans diagnoses don’t immediately seem connected. But actually, it struck me that there are parallels regarding how concepts of the future intersect with bureaucracy.
One thing Ayona highlighted in her presentation was a tension between paternalist bureaucratic structures (which are often keen to hang onto control), and on the other hand an idea of modernity as rationality and efficiency, with an emphasis upon speed and the cutting of red tape. And as a result, government actions are sometimes trying to balance competing demands and discourses, talking about localism and decentralisation while also putting in place institutional and organisational restrictions that limit local flexibility (e.g. restricting who can take on certain roles).
These are very much the debates that underpin discussions of trans healthcare and diagnosis. On the one hand, the old medical structures are time-consuming, inefficient and paternalist. They’re also often reluctant to change, emphasising the importance of medical oversight and closing ranks against upstart entrants. (for a full discussion of trans health care, temporality and constructions of expertise I recommend Ruth Pearce’s book, Understanding Trans Health). In resistance to medicalism, trans activists often position their arguments within concepts of modernity, rationality and efficiency – trans people are not mentally ill, we are perfectly capable of knowing what we want and taking our own medical decisions, and the current system is inefficient, old-fashioned and unsustainable. At the same time, those of us who advocate for stripping back of medical oversight are sometimes (rightly!) challenged by other trans people and their advocates who point out flaws and pitfalls in out arguments. For example, one big problem with relying on rationality as a justification for access to trans healthcare is that it potentially excludes groups of trans people whose rationality is impaired or disputed (e.g. trans people under the age of 18). As a consequence, there is a risk that emphasising rationality tends to reify existing biases – white, middle-class, adult trans people get better access to care than those whose rationality is more ‘suspect’.
Linked to this is the idea that slowness and bureaucracy is ‘safer’. This is very much a feature of debates around trans healthcare and trans legal recognition, where waiting and checking are often couched as being necessary safeguards to protect people from making decisions they could regret. Although somewhat outside my own field, I would think that the idea of bureaucracy as safety is also a component of urban planning discussions, both in terms of obvious concepts of safety (fire hazards etc) but also more broad ideas of what societies consider to be ‘safe’ (scrutinising the wider social effects of any potentially novel change). At the same time, the idea of bureaucratic slowness as safeguarding also relies upon a presumption that radical change in the future is inherently more of a risk than the present. That’s not necessarily the case for individuals, communities or spaces for whom the present is already very unsafe.
At this point, I think the similarities start to break down. The arguments for and against bureaucratic safeguarding of possible futures are rather different for shared public spaces that for individual bodies. Nonetheless, I think it’s useful to think about how discussions in a range of sociological fields may be influenced by concepts of the future and of bureaucratic safeguarding, and Ayona’s paper has definitely inspired me to read and think more around this.